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Course 2 - Orthopedics > Shoulder, Elbow, Hand & Wrist > Flashcards

Shoulder, Elbow, Hand & Wrist Flashcards

1
Q

what are the four articulations of the shoulder?

A

sternoclavicular joint
scapulothoracic articulation
acromioclavicular joint
glenohumeral joint

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2
Q

what are the capsule, ligaments, cartilage, and bone associated with the sternoclavicular joint?

A

Capsule, ligaments: sternoclavicular ligaments
Cartilage: hyaline, articular disc
Bone: clavicle, sternum

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3
Q

what are the capsule, ligaments, cartilage, and bone associated with the acromioclavicular joint?

A

Capsule, ligaments: AC ligaments, CC ligaments
Cartilage: hyaline, meniscus
Bone: clavicle, scapula

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4
Q

what are the muscle, tendon, bursa, capsule and ligaments, cartilage, and bone associated with the glenohumeral joint?

A

Muscle, tendon, bursa:
o Superficial: deltoid, pec, trap
o Deep: rotator cuff, long head biceps
o Subacromial space

Capsule, ligaments: capsule, GH ligaments

Cartilage: hyaline, labrum

Bone: humerus, scapula

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5
Q

what are the muscles and bone associated with the scapulothoracic articulation?

A

Muscles, tendons, bursa: trapezius, serratus, rhomboids, levator, assorted bursas

Bone: scapula, ribs

(no cartilage and ligaments bc not a synovial joint)

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6
Q

patterns of disease for instability

A

mostly young/active people
not much pain
stiffness less common
apprehension

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7
Q

patterns of disease for rotator cuff syndrome

A

middle age/older
pain with reaching and at night
stiffness less common
weakness when loss of tendon attachment

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8
Q

patterns of disease for fractures

A

young/active, and elderly/frail
acute and constant pain
stiffness is potential sequela
less common weakness

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9
Q

describe clavicle fractures

A

MOA: direct blow or FOOSH
features: rarely open, rarely NV compromise, can have thoracic cage injury

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10
Q

describe Tx for clavicle fractures

A

all: sling, RICE initially
non op: if closed, shorted <2cm, medically infirm, not wanting surgery
op: open, severe shortening/displacement, combined injuries, pt preference, painful non-unions

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11
Q

describe AC joint separation

A

MOA: direct blow to shoulder (contact sports)
AC ligaments injured, CC ligaments injured
Rockwood classification of ligament injuries

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12
Q

describe Tx for AC joint separation

A

AC: sling, rice, PT

CC & AC: sling, periscapular muscle rehab, reconstruct torn ligaments for heavy labourers

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13
Q

describe GH joint dislocation

A

common, shoulder dislocation, reduction, can become recurrent

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14
Q

describe anterior GH joint dislocation

A

MOA: arm outstretched, force applied
most common type
shoulder looks squared, NV exam needed
need emergency reduction

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15
Q

what is bankart dislocation

A

avulsion (tearing) of anterior (inferior) labrum (cup-shaped cartilage that reinforces the shoulder joint)

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16
Q

what is Hill-Sachs

A

impaction of post-humerus on anterior glenoid

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17
Q

what is bony bankart?

A

rim fracture of ant-inf glenoid

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18
Q

describe posterior dislocation

A

arms flexed, adducted, internal rotation (seizures, football, electrocution)
same possible dislocations as anterior but with ‘reverse’
associated with humeral head fracture

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19
Q

what are static stabilizers of shoulders

A

bony shapes, concavity, joint capsule, labrum, glenohumeral ligaments, inherent negative pressure

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20
Q

what are dynamic stabilizers of the shoulder

A

rotator cuff muscles, long head of the biceps tendon, scapulothoracic motion, and other shoulder girdle muscles such as the pectoralis major, latissimus dorsi, and serratus anterior

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21
Q

how to radiologically distinguish ant vs post dislocation of shoulder

A

humerus is dislocated in same direction as coracoid: ant dislocation
humerus displaced away from coracoid: post dislocation

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22
Q

what is the mercedes benz sign?

A

3 points at acromion, coracoid, sacular body

if head of humerus is at center, normal

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23
Q

which of the following is not a synovial joint?

  • Glenohumeral joint
  • Sternoclavicular joint
  • Scapulothoracic joint
  • Acromioclavicular joint
A

Scapulothoracic joint

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24
Q

Which of the following muscles do not help operate the scapulothoracic joint?

  • Serratus anterior
  • Infraspinatus
  • Trapezius
  • Levator scapulae
  • Rhomboids
A

Infraspinatus

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25
Q

Select the best pairing of diagnostic features

  • Adhesive capsulitis and apprehension
  • Glenohumeral arthritis and young/active person
  • Seizure disorder and anterior glenohumeral dislocation
  • Elderly and acromioclavicular joint separation
A

Seizure disorder and anterior glenohumeral dislocation

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26
Q

What is true about AC joint separations

  • Result from a direct blow to the AC joint
  • Often require ligament repair
  • Can lead to AC arthritis in future
  • Options 1 and 3
A

Options 1 and 3

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27
Q

what makes up the rotator cuff?

A 
4 tendons arising from scapula 
infraspinatous 
supraspinatous 
subscapularis 
teres minor 
keeps humerus on glenoid, resist upward pull of deltoid
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28
Q

suprascapular nerve innervates

A

infra/supra spinatus

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29
Q

upper/lower subscapular nerves innervate the

A

subscapularis

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30
Q

axillary nerve innervates

A

teres minor

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31
Q

what is the most common rotator cuff tear

A

supraspinatous

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32
Q

describe the continuum of tendinopathy

A

bursitis –> partial thickness tear –> full thickness tear –> arthropathy

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33
Q

describe pathophysiology of AC joint arthritis

A

degenerative OA, post-traumatic arthritis

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34
Q

presenting complaint of AC joint arthritis?

A

pain on ant-lat shoulder, focal > diffuse

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35
Q

physical findings of AC joint arthritis?

A

tenderness over ACJ, pain with adduction, prominent joint

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36
Q

radiography of AC joint arthritis?

A

degenerative changes on XR

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37
Q

Tx of AC joint arthritis?

A 
Rest, ice/heat, activity mod, OTC meds
Topicals, NSAIDs, exercise
Corticosteroid
Rx (injection of joint)
Surgery and chronic management
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38
Q

pathophysiology of long head of biceps (LHB) tendinopathy

A

Degeneration of tendon in bicipital groove

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39
Q

presenting complaint of LHB tendinopathy

A

ant shoulder pain, pain w resisted biceps activity

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40
Q

physical findings of LHB tendinopathy

A

Tender over LHB, pain w resisted flexion/supination

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41
Q

radiographs of LHB tendinopathy

A

thickening, tearing, fluids in tendon sheath on US/MRI
rupture does not require surgery
size of tear and symptoms do not correlate

42
Q

pathohysiology of rotator cuff tears

A

degeneration of rendon related to vascularity, repeat use, chronic injury

43
Q

presenting complaint of rotator cuff tears

A

pain w overhead reach, pain at night, weakness overhead

44
Q

physical findings of rotator cuff tears

A

discomfort w strength test and impingement

AROM

45
Q

radiographs of rotator cuff tears

A

x-ray: normal or rounding/sclerosis of greater tuberosity, prox migration of humeral head
US: good for full thickness SS, IS tears, not for partial or SSc tears
MRI not routinely required

46
Q

Tx for rotator cuff tears

A

stepwise Tx plan, subacromial injection in bursa, surgical repair, supervised active rehab

47
Q

what is scapular dyskinesis?

A

abnormal movement of the scapula movement

48
Q

what is the region in cervical spine most associated with shoulder diseases?

A

C5-6

49
Q

MOA of corticosteroids

A

inhibit prostaglandins and leukotienes, reduce inflammation/pain

50
Q

advantages and pitfalls for corticosteroid use

A

prognostic/diagnostic use

can lead to hyperglycemia in diabetics, using it without rehab is useless

51
Q

long-head bicep ruptures does not/do require surgery

A

does not

52
Q

T/F: size of tear and symptoms are correlated

A

F

53
Q

describe the elbow joint

A

3 articulations in same capsule and synovial fluid space, hinge joint
radial notch of ulna + radial head (proximal radioulnar)
trochlea + radius (humeroradial)
trochlea + ulna (humeroulnar)

54
Q

describe humeral shaft fracture

A

fracture anywhere along the shaft of the humerus
not common
FOOSH
close to radial nerve

55
Q

describe deficiency in radial nerve

A

wrist drop, inability to extend fingers, numbness along forearm
supplies triceps, extensor in forearm

56
Q

Tx for humeral shaft fracture

A

straight cast, plate and screws

57
Q

describe distal humerus fracture

A

not common unless elderly (osteoporosis)
FOOSH, sometimes open
close to ulna

58
Q

describe deficiency in ulnar nerve

A

supplies hand intrinsic muscles, some flexors, 1.5 digits

59
Q

describe Tx for distal humerus fracture

A

always surgery, sometimes elbow replacement

60
Q

describe radial head fractures

A

common, more F than M

FOOSH, direct axial load or rotation force

61
Q

Tx for radial head fractures

A

wrist exam and radiograph
sling & icepack, sometimes screw, sometimes replacement
DONT IMMOBILIZE; stiff elbows are hard to deal with

62
Q

describe olecranon fractures

A

can be common
direct blow to elbow or FOOSH
can be open
range from simple –> smashed

63
Q

static stabilizers of the elbow

A 
ulnohumeral joint (coronoid)
medial (ulnar) collateral ligament (MCL)
lateral collateral ligament complex (LCL) 
radiocapitellar joint
surgical reconstruction
64
Q

dynamic stabilizers of elbow

A 
anconeus
brachialis
triceps
biceps
active focused rehab
65
Q

pathophysiology of elbow dislocations

A

posteolateral most common
axial loading
supination/external rotation
valgus posteolateral force

66
Q

what is the terrible triad?

A

radial head fracture, coronoid fracture, ulnar collateral ligament injury

67
Q

Tx for elbow dislocations

A

non-op: closed reduction, splinting @ 90 degrees
op: LCL, MCL repair
fix ulnar, radial should resolve

68
Q

describe pathophysiology of distal biceps rupture

A

excessive eccentric tension as the arm is forced from a flexed to an extended position

69
Q

symptoms of distal biceps rupture

A

palpable defect, muscle rolled up

70
Q

Epicondylitis is defined as

A

inflammation of epicondyle
lateral is tennis elbow
medial is golfer’s
pain and inflammation around elbow

71
Q

pathophysiology of epicondylitis

A

repetitive micro-trauma leading to changes in collagen and vascularity and finally structural incompetence

72
Q

clinical features of lateral (tennis elbow)

A

pain with passive flexion and resisted extension

73
Q

clinical features of medial (golfer’s elbow)

A

pain with passive extension and resisted flexion

74
Q

Select the best combination of named bony bits and where to find them

Olecranon and proximal humerus 
Coracoid and anterior scapula 
Medial epicondyle and proximal ulna  
Sternoclavicular joint and distal clavicle 
Coronoid and anterior scapula
A

Coracoid and anterior scapula

75
Q

Which of the following is true about rotator cuff problems?

Physiotherapy is unlikely to produce satisfactory symptom resolution
The size of the tear is predictable by symptoms
You should get an MRI to try to get them in to the surgeon faster
There is commonly no clear injury that triggers symptoms

A

There is commonly no clear injury that triggers symptoms

76
Q

Which of the following is not a static stabilizer of the elbow joint?

Bony shape of the ulnohumeral joint 
Biceps 
Lateral ulnar collateral ligament 
Medial collateral ligament 
Joint capsule
A

Biceps

77
Q

Choose the best combination of clinical features

Lateral epicondylitis and pain with resisted wrist extension
Medial epicondyltitis and pain with resisted wrist extension
Olecranon fracture and radial nerve injury
Distal humerus fracture and non-operative treatment

A

Lateral epicondylitis and pain with resisted wrist extension

78
Q

describe carpal tunnel syndrome

A

compression of median nerve due to increased pressure in carpal tunnel

79
Q

presentation of carpal tunnel syndrome

A

nocturnal pain, numbness/tingling, in thumb and index and long fingers, symptoms get better with shaking out hands, thenar wasting

80
Q

investigations for carpal tunnel syndrome

A

tinel’s sign
phalen’s
reverse phalen’s
durkan’s

81
Q

Tx of carpal tunnel

A

non-op: night time splinting, corticosteroid injections

op: carpal tunnel release

82
Q

describe flexor tenosynovitis

A

acute bacterial infection in the flexor tendon sheath

83
Q

investigations for flexor tenosynovitis? 4 things for Kanavals signs

A

fusiform swelling, pain with palpation, flexed posture, pain with passive stretch

84
Q

Tx for flexor tenosynovitis

A

surgery to remove pus + ABx + irrigation
high incidence of post op stiffness
aggressive rehab after surgery

85
Q

describe scaphoid fracture

A

largest carpal bone, 80% surface is articular
FOOSH
force to wrist in hyperextension (>90 degrees)

86
Q

what does the scaphoid articulate with

A

Articulates w radius, lunate, capitate, trapezoid, trapezium

87
Q

presentation of scaphoid fracture

A

wrist swelling, pain in snuff box, pain with ulnar deviation

88
Q

complications of scaphoid fracture

A

avascular necrosis and non-union (retrograde blood supply)

can lead to SNAC (scaphoid nonunion advanced collapse)

89
Q

investigation for scaphoid fracture

A 
not always on XR, bone scan or CT
compression test (push 1st MC into scaphoid)
90
Q

Tx for scaphoid fracture

A

splint, CT if abnormal, surgery if displaced
smaller piece = higher chance of not healing
higher risk if delay in Tx

91
Q

describe ulnar nerve compression

A

compression of ulnar nerve @ elbow

cubital tunnel at elbow close to medial epicondyle

92
Q

presentation of ulnar nerve compression

A

numbness in D4, D5 - worse with elbow flexion
hypothenar and interosseous wasting
weakness in muscles innervated by ulnar nerve

93
Q

investigation for ulnar nerve compression

A

Froment sign
Wartenburg sign
Duschenne’s sign

94
Q

Tx for ulnar nerve compression

A

non-op: splint at night (straight), activity modification (avoid leaning on flexed elbow)
op: decompression, transposition

95
Q

describe ulnar collateral ligament injury (skier’s thumb)

A 
tear of ulnar collateral ligament 
hyperflexibility, laxity in thumb
need US to visualize 
non-surgical for partial tears, splinting/immobilization 
surgical for full tear
96
Q

describe Dupuytren’s contracture

A

nodules in palm, progress to hard cords, thickening in palm, finger doesn’t straighten all the way (D4&5 affected most)
genetic, European descent

97
Q

describe mallet finger

A 
injury to the extensor digitorum tendon at DIP
cannot extend DIP, pain, numbness
blunt force (ball)
splint for Tx
98
Q

what is high ankle sprain

A

MOI: external rotation and dorsiflexion

anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL) torn, inferior tib-fib also torn

99
Q

TX for sprains

A

NSAID
protective bracing
PT
surgical reconstruction for high grade

100
Q

define plantar fasciitis

A

inflammation of thick connective tissue that support arch of foot
focal pain, morning pain/stiffness

Course 2 - Orthopedics (7 decks)

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